Wednesday, April 25, 2018

How to Support Your Child's Anxiety (While Keeping Your Own in Check)



Sometimes life here is sensory bins, light tables, play gardens and baking cookies. Other times, life here is kneeling in a public bathroom, wearing a disposable "firefighter's hat" and holding the hand of a little boy who is now using the potty (Yay!) and is afraid of loud noises like automatic toilets flushing and electric hand dryers. For S, loud and unpredictable sounds are overwhelming. Not all loud sounds, mind you. He is fascinated by drums, music, motorcycles, sirens, blenders, food processors, even the vacuum cleaner. But there is a fine line between fear and fascination, and some of these sounds began their life for him on the other side of that line.
S's sound sensitivity has its pros and cons, for sure.  He is keenly aware of sounds in nature, like birds chirping, bugs buzzing, dogs barking... He is particularly musical and rhythmic (the apple does not fall far from the tree). Just as easily as he can hone in on one sound to the exclusion of all else, he can also channel his focus (or lose it entirely). As a sound sensitive adult, I can empathize with his experience. I can remember getting lost in department stores because I got lost in the recorded music being played. I still loathe the sound of the vacuum, balloons popping, more than one song playing or conversation happening at once... I am also musical. I began demonstrating the ability to play songs I heard by ear at the age of three and began piano lessons shortly after. I started writing my own music at the age of 9, culminating in over 100 songs before I transitioned to writing mostly parenting and preschool jingles.
For S, a public bathroom is just about the most intense audio experience he could face right now. In a world where toilets, hand dryers, paper towels and even soap are automated and make unpredictable noises, the whole experience is out of his control. To top that off, many restrooms are shared spaces and someone could come in and use any of these loud and unpredictable appliances without any warning. When you are also new to the world of toileting and all that it entails, it is almost too much. It is one of the few fears that leads him to want to avoid a situation altogether and "just go home."
As a mom who leans toward the side of worrying herself, I also tend to reach that fight or flight response when I see it ignited in my kids. More and more, I began to ponder outings we could do so quickly that a bathroom stop would not be necessary. Or how bad would it be if I just let him have an accident and changed him in the car? Could he pee outside at the park someplace far off and out of view? Maybe we will just go to the library and Walmart until he overcomes his fear of every other bathroom in the world. But alas, our lives cannot stop, nor should they. Which is the point I reached while crouching in the corner of that bathroom yesterday, decked to the nines in my fancy shmancy disposable hat. The first order of business in dealing with childhood anxiety is getting your own anxiety in check...

Check Yourself Before You Wreck Yourself! Ah, how that expression conjures all sorts of nostalgia... But it is a great reminder that you must affix your own oxygen mask before assisting others. And speaking of oxygen, a deep breath (or even a few) might not hurt here...
Childhood fears are typically normal and usually temporary. For a great comprehensive list of common childhood fears based by age (and tips on dealing with them), check out this article at Anxious Toddlers. Having a fight or flight response is actually a helpful thing. We want our children to grow to recognize risk and danger and respond accordingly. That said, we also want them to grow to experience and act on this response at appropriate times. As adults, we likely even remember some of our own childhood fears. Some of them we overcame and perhaps a few still remain. (I'm still terrified of throwing up, and I mean terrified.) As parents, we can do a lot to support our children's process in experiencing, working through, and overcoming fears and anxieties. This blog is all about play and play is truly a way that children are able to work through and process strong emotions. You can read up on some previous posts related to coping with childhood anxieties here.

Even while knowing all of the benefits of childhood fears and knowing that they are generally normal, healthy and temporary responses, it can be difficult not to experience your own strong emotions of frustration and concern. Unfortunately, sometimes our children read this emotional response in us as a reason to further perpetuate their own anxiety. If Mommy seems worried and upset, perhaps I should be, too. If we can get our own reaction in check (or at least delay it a bit and vent the frustration later on behind closed doors), we can better assist our little ones in shrinking those larger than life fears back down to a manageable size.

Preparation is (Almost) Everything: I say "almost" because when it comes to fears and worries, you cannot always predict a trigger. That said, if you do know your child may face a fear trigger, whether it's getting a shot at the doctor, using a public restroom or being separated from you for the first time (or several dozen times) at school--you can do a bit to prepare. This is a balancing act. There is a line between talking about an event in a way that prepares a child and reduces anxiety and talking about an event in a way that causes more worry and anxiety as it approaches. This threshold is different for every child and can be difficult to read. As a teacher and as a parent, I always find myself assessing (and re-assessing) when the best time is to talk about an upcoming event that may trigger anxiety. It can be helpful to talk about an event afterward that has a more positive association. This does not necessarily mean you are offering a reward for bravery (although you can!) but simply that there is something to look forward to along with the aspect that is less desirable. "We are going to the dentist today and on the way home, I thought it might be fun to stop at the book store."

Preparation also might involve having support tools with you, whether that is a security or transitional toy/blanket, a distraction (toys, games, cell phones/tablets), or portable objects that help with calming down (calm down jars/sensory bottles, stress balls, lavender essential oil, really whatever works here!). Familiar objects like family photos or a special bracelet or necklace made together or a small object to hold in a hand or pocket can sometimes help with separation anxiety. Fear and discomfort in public restrooms can sometimes be reduced by bringing a familiar portable seat cover. A plastic dinosaur with teeth can "demonstrate" how his teeth get cleaned at the dentist before it's a child's turn and a favorite baby doll or stuffed toy can come along for a check up. Social stories can be written, drawn and dictated by children along with your help to work through fear inducing scenarios and their aftermath. If possible, try to allow yourself extra time to navigate these scenes by arriving early or not having to rush out to another commitment. If you will not be with your child when he/she will experience a fear trigger, it can be helpful to go over who the helpers are, whether that is a teacher, a babysitter, a relative or friends. It can also be helpful to go over calming techniques. This might look a bit like this:
"And who can you go to if you need some help? [Teacher/babysitter/friend] can help you, right? And what can you do if you feel worried/sad?" Allow your child to come up with some of his/her own ideas and feel free to add in your own. "You can ask for a hug/hold a hand/take a deep breath/cover your eyes/ears..."

In the Moment: There are many tools to handle those "in the moment" fear responses. Once you've got your own wits together (this can sometimes be the hardest part!) you're ready to reach into your bag of tricks. Here are a few of my own that are helpful, but truth be told, this bag needs to be a bottomless pit. I'm always reaching for new tools when one doesn't quite do the trick or stops being effective. It's also useful to know that you and your child will not always handle these intensely emotional moments in "the best way possible." That is OK. While we strive to navigate these stormy waters as gracefully as we can, I firmly believe that what we do before and afterward are equally, if not more important. And remember that a moment is just that: a moment. It will pass. There will be many others. For better or for worse, when it comes to supporting a child's anxiety, there are many second (third, fourth and millionth) opportunities.


  • Scene Scavenger Hunt: When I enter a public bathroom with S, we do a Scene Scavenger Hunt. "This bathroom is a family bathroom, which means it's just us in here." or "This bathroom has three stalls and three toilets. Many people can use it at once." "I see a sink and a hand dryer and a paper towel dispenser. And look, there's some soap! Oh, and there's a trash can... These toilets have handles that you push down to flush." or "This toilet has an automatic flusher. Shall I cover it up with toilet paper [or I recently heard a suggestion to use sticky notes] so we can flush it at the end?" A scene scavenger hunt can also include aspects that are protective in the environment. This may be people or objects that are comforting or identifying why a space is safe/helpful. The doctor's office can be scary but it is also a place where people who are sick can be helped and where doctors make sure that people are healthy. 
  • Helpful Language: "Don't be scared," "Don't cry," "Be brave," and "It's not scary," are not always the most helpful phrases. For one thing, fear is not something that can instantaneously be turned off to make way for bravery. And bravery is not the absence of fear, rather it is the ability to move forward even in the face of fear. Crying is a natural response to many strong emotions, fear included, and actually releases endorphins in the brain that help to calm an anxiety response. That said, when intense emotions do arise and breathing becomes more rapid, it can be helpful even as a child is crying to assist with some slow, deep breathing. The language I prefer includes three parts: 
    • validating/acknowledging the feeling: "This is really scary for you." "You feel really nervous." "The dog really worries you."
    •  a conjunction that does not negate that statement (AND, not BUT)
    • a restorative affirmation "You are safe." "I am here." "I will stay with you." 
An example of putting that all together might sound like this: "The hand dryer is really loud and loud sounds are uncomfortable. You can hold my hand and I will stay here with you as long as you need." or "The vacuum makes a really loud sound and it is safe." With separation anxiety, this is a bit different and might sound a bit more like this: "Saying goodbye is really hard and I will be back after lunch." 
  • Calming techniques like deep breathing, singing a song, distraction, humor, comforting touch or just about anything that can diffuse and get you through the moment (even if it's not ideal or sustainable) come into play here. Bribery, sweets, prizes and rewards may not be the most sustainable option when it comes to childhood anxieties, but sometimes you gotta do what you gotta do. Ideally you want your comfort measures to be ones that you can always access and certainly options like mindful breathing, a comforting song or holding a hand are generally a preferred option, but don't beat yourself up over resorting to the powerful currency of lollipops, stickers or whatever gets you through--particularly for less frequently experienced fear triggers like getting hair cuts, dental checks or shots.
  • Slow the Boat Down! If your child has a strong fear of something, chances are there are many other children (and parents) in the same boat! It can be helpful to remember you and your child are not alone and then to focus in on how to slow that boat down. Fear ignites a strong and speedy physiological response. It is exactly what the body needs to fight a predator or flee from the scene of danger. Yet, if that predator happens to be a porcelain toilet bolted to the floor, you probably don't need to run so fast and that level of response might be overkill for the system. You want to help your child slow that response. This can be done through modeling and involves slowing your own pace. Using slow and deliberate speech, taking full and deep breaths and reducing extraneous factors that are unhelpful are all ways to assist a child in fight or flight mode. You may feel like saying a lot, but saying less and merely being present with a child can go a lot further in the moment
  • How big is your bubble? Several years ago when I was teaching, I had a student who had particularly strong emotional responses to a variety of stimuli. I began to use some imagery with him to help him decide and control how big his problems were in a moment and be able to move forward. Eventually, all I needed to say was "How big is your bubble?" and he could work through this process independently. You would introduce a technique like this outside of a high intensity moment so that you can access it with familiarity once a fear response arrives. Here's how it works:
"Imagine that [your worry/problem] is a bubble. [You can be specific here--for S, I would say "Imagine that the sound of the hand dryer is a bubble.] Worries can feel really big and the more worried/upset you feel, the bigger that bubble gets. Hold out your hands and lets blow up that bubble. How big is your bubble? Oh my, that is big! You feel really worried about _____. Now can you use your hands to make the bubble smaller? [Model slowly squeezing and pushing hands inward]. Can you gently blow the bubble away? [take a big, deep breath and slowly blow out] Can you pop the bubble and make it disappear? [poke a finger at the imaginary bubble and make a popping sound] What else can we do with the bubble so that it won't be so big?" [Children have great ideas with this one! One little boy even had the idea to put himself inside of his bubble and float away!] Imagery techniques like this one can help children slow down their thoughts and feelings and take deep breaths while also feeling an aspect of control over the size and magnitude of their experience. Once this is practiced a number of times "outside of the moment," it can be utilized "in the moment" as simply as asking "How big is your bubble? Can we make it smaller?"

Outside of the Moment: Moments of intense anxiety can feel like forever, but relatively speaking, they are a very small portion of the bigger picture of childhood fears. There are supportive tools that can help when life is calm so that the next time you're in the moment it's easier to get through.

  • Be a Solution Sleuth: Every great detective knows how to scour the scene of a crime for evidence. Now you and your child get to play detective and find all of the helpful and useful evidence you can to diffuse the fire of fear and simultaneously add kindling to your child's self esteem. You'll be tapping into some factual resources about the things that frighten your little one. Libraries are a great resource for books both fiction and non-fiction about all kinds of common childhood fear triggers from thunder to hospital visits, first days of school and spiders--you name it, they've got it. Information is power and fears make us feel powerless. Armed with helpful information, we can regain a bit of power over the response and reaction. Do be mindful to balance how much information you provide. Again, the line is not always definitive, but monitor how your child is responding as you research and explore and be sensitive to times when reading and talking about worries are not the most helpful (for some, bedtime is not a good time to talk about fears).
As you're gathering evidence to shrink down larger than life fears, you'll also want to collect some evidence to help build up your child. Here it is useful to tap into past occasions on which he or she was able to overcome a difficult obstacle. It is also noteworthy to mention that while praise is sometimes helpful, it is even more helpful in these times to shift the focus on their own perception of their accomplishments. With S, that looked a bit like this: "Do you remember how you used to feel afraid of the dogs at this park and now they don't worry you at all anymore, do they? We came back again and again and after a while, you even liked to sit and watch them play! I wonder if we keep coming back again and again, if after a while, the bathrooms here might not feel so scary either." or "I can remember when you were too afraid to even touch the ropes at the gym and now you swing on them like a monkey! You must feel really proud about that!" Tapping into these moments of accomplishment stocks your file box full of supportive evidence that they can overcome this and any hurdle in their path. 
  • Be honest. I am a huge supporter of honesty when it comes to childhood fears. I do not believe it is helpful to lie in order to "protect" a child from something that scares him. Shots do hurt. Someone might come in the bathroom and turn on the hand dryer. Dogs sometimes bite, but most of the time they are safe, especially if you ask the owner before coming close and give them space. Bees sometimes sting to protect themselves but most of the time they do not, especially if you are still. And on the other side of that coin, monsters are not real. Ghosts, witches, etc. are not real. Bears do not live nearby our house. Never use your child's fear as ammunition. It will likely come back to bite you both in the tush! If your child is intensely fearful of being left, it is not likely useful to say "see ya! I'm leaving" and walk away in the bookstore when she doesn't want to go home. Sure, she will probably follow you right away, but separations in other places will also likely take longer and be more intense as her trust wavers. 
  • Be an example. I think it is important for children to know that adults had fears as children, too, and even that adults still have fears. I tell my kids about the things that scared me when I was young and even about the things that still do. I tell them what I did to get through the strong feelings and who helped me and how. I tell them that I used to be very afraid of getting my hair cut, but more and more, I practiced and one day, I didn't need to sit on my mommy's lap anymore and in fact, one day I even started to love getting my hair cut. I liked to play about it and pretend about it and now it isn't scary for me at all.
  • Make a space for worries. While it is a delicate dance to know when, where and how often to talk about the things that worry your child, it is important to make a space where those thoughts and discussions are safe and welcome. We have started a new nightly routine instigated by S himself. Each night we always sing and talk about our favorite thing from the day and now we also talk about a "least favorite thing," which usually includes something that worried or upset S. For him, naming the experience when he's not in it helps to diffuse it and allows him to let go and move forward. If this is something that is helpful to your child, go for it! If talking about (particularly before bed) induces more anxiety and worry over it, this may not be the best time or place. You might instead look at role playing about it earlier in the day. Either way, do allow your children to know that you are a safe person they can talk to about their fears and worries whenever they need to do so. You can also help them to identify other safe people to talk to.
  • PLAY! I've said it so many times already, but play is the natural way that children work through their fears and worries. Sometimes observing their play can help us identify what they worry about. Other times, we can engage in intentional dramatic play with them that assists in the process. Allowing ample time and opportunity for play ensures a safe and developmentally appropriate space for children to navigate their anxieties.
General Maintenance: The above are just a few things that can support a child coping with fear and anxiety. In general, there are things we can do for our children and ourselves to maintain a healthy control over anxiety and fear. These include (but are not limited to):
  • Exercise, particularly cardio exercise helps release endorphins in the brain that combat the chemicals released during an anxiety response. Yoga can also be a great tool to combine aspects of exercise, breath control and thought re-framing/mindfulness.
  • Adequate sleep and nutrition support the whole system in functioning through the day's highs and lows
  • Mindfulness techniques can be really helpful with children and adults in coping with anxiety--there are fabulous books out there and online resources
  • Spiritual practice and awareness of something larger than fears and even larger than us can be a huge protective factor. If you adhere to particular religious community or spiritual practice, this is a great resource!
  • Having patience is easier said than done, but trust and know that this, too, shall pass. S used to be immensely terrified of the vacuum cleaner and now he is first in line to help with the chore, even toting along his own toy vacuum!
  • Know when to push forward and when to step back. We do not want to see our children paralyzed by fear. Sometimes that idea triggers our own fear response (it does for me). And yet, we have to navigate (again and again) when to push forward and when to step back. Picking battles does not mean you surrender the war. Some days it is easier just to avoid the places that don't have S-friendly bathroom options. Some days it is necessary that we go there. Some days I have all the patience and time in the world and some days I do not. It's OK to change your mind. It's OK for your child to change his mind. Certain fears are unavoidable. We cannot avoid taking our children to the doctor because it is scary. Some fears are avoidable. If your child is terrified of heights, you probably don't need to force him to become a tightrope walker. But some fears fall into a more grey area and you have to decide if it is important to push forward and really ask yourself why. A child who is afraid of dogs might wish to avoid going into a house with one or might wish to avoid going to the park or might wish to avoid going outside altogether when he hears one barking. This is where you have to decide where the line gets drawn. Unless you are a dog lover yourself, you probably don't have to get one as a pet. But are you OK not going to the park? Can you get your child to walk past the neighborhood house with the yappy chihuahua in the front yard or does he turn into a wet noodle requiring you to carry him and all your groceries at once? The answer with these issues are different from person to person and it's something each family must decide on their own.
  • Watch for less obvious signs of anxiety. Some children are verbal about their fears while others are more withdrawn. If you notice your child eating, sleeping and behaving differently, it can be a sign that something worries him or her. Some children may act silly when they are worried. Some may put their hands or fingers in their mouths. Some act with aggression when they are afraid and still others may be more tearful or emotional than usual but not mention specifically what is bothering them. Nightmares and sudden bed wetting can also indicate worry and anxiety. Children do not always process something that is scary as quickly as adults. It may take days, weeks or even months after a significant event for something to show up on the radar that indicates they were worried by it. Children also may revisit a significant event like this through play or talking repeatedly as time does pass. 

  • This, too, shall (likely) pass. Just over a year ago, our smoke detector went off unexpectedly and S was very afraid. He was visibly distressed while it was beeping loudly and later in the day became suddenly paralyzed with fear and anxiety when he discovered that Barnes and Noble had smoke detectors, too! We had to leave the store, a very-pregnant me carrying him on one hip and come home. I called our pediatrician as S stood with his hand in his mouth in our front foyer refusing to come any further into the house. He assured me that this was likely a normal childhood fear and that short of bringing him in to have his elbow extracted from his throat should he shove his hand down far enough, probably we wouldn't need any professional intervention. Sure enough, S eventually made it back to the living room and back to living. Over the last year, we named our smoke detectors (George and Monkey), talked about them, had fire drills at school, and most recently, S built a one legged, one eyed, one-shoed Smoke Detector Protector that watches our smoke detectors each day when he goes to school "to keep them safe." Childhood fears can be intense in their prime, but they generally simmer down over time with support.
It Takes a Village: After all is said and done, I am reminded that it truly does take a village to raise a child and today that village is different. It's not all within the walls of our home or even the parameters of our neighborhood. It can feel isolating and it can also feel empowering to know that our village has now expanded as wide as the world and the click of a mouse. Use your village, whatever that may entail. Ask for support from other parents, teachers and perhaps your pediatrician. An objective set of eyes can help you to know whether you're dealing with a common childhood fear or whether there's a stronger underlying anxiety issue that needs to be supported. Many times, it can be comforting to know that other parents and children are dealing with the same experiences and you may even walk away with some fresh ideas and tips. If generalized anxiety is playing a role, there are amazing resources and tools through behavioral therapies and play therapy to support children and the adults around them. 

Toilet seat cover hats and toilet paper scarves might make me question my current fashion sense, but in addition to all the tools in my belt, a sense of humor and plenty of patience are vital. Play, as always, is invaluable. And that's just what we'll be doing until the next time...

Happy Playing!

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